Treatment of Rotator Cuff Syndrome
What is rotator cuff syndrome?
The rotator cuff is comprised of four muscles - supraspinatus, infraspinatus, subscapularis and teres minor and these muscle serve as a dynamic stabiliser of the upper arm and creates movement of the upper arm and shoulder blade. Rotator cuff syndrome can be acute or chronic in nature, with an injury arising from a single traumatic event (e.g. fall or direct impact trauma) or develop gradually from degenerative processes. The research suggests that the diagnoses of subacromial impingement syndrome, subacromial bursitis, rotator cuff tendonitis and rotator cuff tears (partial- or full-thickness) arise from tendon degeneration and/or the repetitive or excessive contact of the rotator cuff tendons with other anatomic structures in the shoulder, and usually result in functional loss and disability. In degenerative rotator cuff syndrome, it is possible for the underlying processes to be occurring over time with limited or no symptoms, but an incident (such as a posture which uses the end of range motion of the shoulder or sudden increase in load upon the tendon) can precipitate pain from the degenerative tendon.
What else can rotator cuff syndrome be called?
Rotator cuff syndrome can also be referred to as shoulder impingement syndrome, subacromial impingement syndrome, subacromial pain syndrome, subacromial bursitis, rotator cuff tendinopathy and rotator cuff tears (partialor full-thickness).
What are the symptoms of rotator cuff syndrome?
Presenting symptoms of rotator cuff syndrome will include shoulder pain symptoms, sometimes neck and upper arm pain (deltoid area), loss of range of motion or pain restricted range of motion and weakness. Most often people will have difficult lifting or carrying things, especially when further away from the body such as lifting a full kettle or putting plates in the top cupboard. Night pain may indicate rotator cuff syndrome. Location and nature of pain: pain with overhead activity may indicate rotator cuff syndrome. Referred pain from cervical spine is common and characterised by sharp pain originating from the neck and radiating down the arm. Movement of the neck may reproduce symptoms.
Diagnostic criteria for rotator cuff syndrome
Diagnosis of rotator cuff syndrome requires a thorough history-taking which should include the following factors and consideration of their implications: age, occupation and sports participation, medical history, mechanism of injury, pain symptoms, weakness and/or loss of range of motion (body function impairments), activity limitations and social situation. Assessment of rotator cuff syndrome requires physical examination which should include the following: direct observation of the shoulder and scapula; assessment of active and passive range of motion; resisted (isometric) strength testing; and evaluation of the cervical and thoracic spine (as indicated). It may also include administration of other clinical tests dependent upon the experience and preference of the physiotherapist.
What other conditions could it be?
Shoulder bursitis, subacromial pain syndrome, AC joint injury, rotator cuff tendinopathy, rotator cuff partial tear, subacromial impingement syndrome.
What are the most appropriate outcome measures to evaluate the treatment of rotator cuff syndrome?
Our physiotherapists and exercise physiologists use the shoulder pain and disability index (SPADI), the QuickDASH and the upper extremity functional index (UEFI) outcome measures for assessing treatment of rotator cuff syndrome.
Guideline-based treatment of rotator cuff syndrome
Initial management of rotator cuff syndrome recommendations includes the following:
Individuals should be prescribed paracetamol as the initial choice for mild to moderate pain.
Individuals with acute shoulder pain may be prescribed NSAIDs (either oral or topical) for pain relief. NSAIDs may be prescribed alone or in conjunction with paracetamol.
Individuals may intermittently apply heat for short periods for pain relief, especially prior to exercise.
Individuals should be initially treated with exercise prescribed and reviewed by a suitably qualified health care provider. There is no evidence of adverse impacts for prescribed exercise programs for patients with rotator cuff syndrome.
Manual therapy may be combined with prescribed exercise by a suitably qualified health care provider, these treatment providers are trained in the prescription and modification of exercises consistent with pathology.
Clinicians may consider acupuncture in conjunction with exercise; the evidence does not support or refute the benefits of acupuncture - as such our physiotherapists do not use acupuncture.
The evidence suggests that therapeutic ultrasound does not enhance outcomes compared to exercise alone.
What guideline/consensus statements does Agility use in the treatment of rotator cuff syndrome?
Hopman K, Krahe L, Lukersmith S, McColl AR, & Vine K. 2013. Clinical Practice Guidelines for the Management of Rotator Cuff Syndrome in the Workplace. The University of New South Wales.